Postpartum Nursing Care

• Postpartum nursing care focuses on the period after childbirth, typically the first 6 weeks, involving significant physiological and psychological adjustments for the mother
• Care includes monitoring the mother's physical recovery, emotional well-being, and providing education on newborn care
• The family is included in the recovery process and taught the knowledge needed for after discharge

Physiological Changes

• Uterine Involution: The uterus returns to its pre-pregnant size through contractions, aided by breastfeeding and oxytocin release
• Lochia: Vaginal discharge after birth progresses from lochia rubra (red) to lochia serosa (pink/brown) to lochia alba (white/yellow)
• Cervical Changes: The cervix gradually closes but never returns to its pre-pregnant shape
• Cardiovascular System: Blood volume and cardiac output decrease to non-pregnant levels
• Endocrine System: Estrogen and progesterone levels drop significantly after placental expulsion
• Urinary System: Diuresis occurs to eliminate excess fluid volume
• Gastrointestinal System: Bowel function may be slow to return, leading to constipation
• Vital Signs: Changes in temperature, pulse, respirations, and blood pressure are monitored to detect complications
• Weight Loss: Initial weight loss occurs due to the delivery of the baby, placenta, and amniotic fluid, followed by gradual weight loss

Psychological Adaptation

• Taking-In Phase: The mother is passive and focuses on her own needs, recounting the birth experience
• Taking-Hold Phase: The mother becomes more independent and interested in caring for the newborn
• Letting-Go Phase: The mother adjusts to her new role and separates from the fantasy of the perfect birth/baby
• Postpartum Blues: Feelings of sadness or tearfulness are common in the first few weeks
• Postpartum Depression: More severe and persistent mood changes require professional intervention
• Bonding and Attachment: The development of a close relationship between the mother and baby is fostered through early and frequent interaction
• Maternal Role Attainment: The process by which a woman learns and adapts to the maternal role
• Family Dynamics: Adjustments occur as the family adapts to the new baby
• Cultural Considerations: Cultural beliefs and practices influence postpartum care

Nursing Assessments

• BUBBLE-HE: Acronym for Breast, Uterus, Bladder, Bowels, Lochia, Episiotomy/Laceration, Homan’s sign (though now Calf assessment), Emotional Status
• Breasts: Assess for engorgement, nipple soreness, and proper latch
• Uterus: Palpate the fundus to assess involution and firmness
• Bladder: Monitor urinary output and assess for distention
• Bowels: Assess bowel sounds and monitor for constipation
• Lochia: Evaluate color, amount, and odor
• Episiotomy/Laceration: Assess for signs of infection or hematoma
• Pain: Evaluate and manage pain using pharmacological and non-pharmacological methods
• Emotional status: Assess the state of mind of the patient and willingness to accept assistance

Nursing Interventions

• Promoting Comfort: Provide pain relief, perineal care, and support for breastfeeding
• Preventing Infection: Educate on hygiene practices and monitor for signs of infection
• Promoting Nutrition: Encourage a balanced diet and adequate hydration
• Promoting Elimination: Encourage ambulation, fluids, and fiber to prevent constipation
• Promoting Rest: Encourage rest and sleep to aid recovery
• Promoting Bonding: Facilitate skin-to-skin contact and early breastfeeding
• Education: Teach about newborn care, postpartum changes, and warning signs
• Safe pain control including pharmacological (oxycodone) and non-pharmacological interventions

Postpartum Complications

• Postpartum Hemorrhage: Excessive bleeding after childbirth; early or late
• Infection: Uterine infection (endometritis), wound infection, or mastitis (breast infection)
• Thromboembolic Disorders: Deep vein thrombosis (DVT) or pulmonary embolism (PE)
• Postpartum Psychiatric Disorders: Postpartum depression, postpartum anxiety, postpartum psychosis
• Urinary Tract Infections: Common due to catheterization or bladder trauma
• Hematoma: Collection of blood in the perineal tissues
• Subinvolution: Failure of the uterus to return to its pre-pregnant size

Postpartum Hemorrhage

• Definition: Blood loss of more than 500 mL after vaginal birth or 1000 mL after cesarean birth
• Causes – the 4 T’s: Tone (uterine atony), Trauma (lacerations), Tissue (retained placental fragments), Thrombin (coagulation disorders)
• Uterine Atony: Most common cause; uterus fails to contract adequately after delivery
• Lacerations: Cervical or vaginal tears
• Retained Placental Fragments: Small portions of the placenta remain in the uterus
• Coagulation Disorders: Conditions that impair blood clotting
• Risk Factors: History of PPH, multiple gestation, polyhydramnios, prolonged labor, use of oxytocin
• Nursing Actions: Fundal massage, IV fluids, medications (oxytocin, misoprostol, methylergonovine), blood transfusion, monitor vital signs

Postpartum Infection

• Endometritis: Infection of the uterine lining
• Wound Infections: Cesarean incision or episiotomy site
• Mastitis: Breast infection
• Risk Factors: Cesarean birth, prolonged labor, PPROM, multiple vaginal exams, manual removal of the placenta
• Signs and Symptoms: Fever, chills, abdominal pain, foul-smelling lochia, wound drainage
• Nursing Actions: Administer antibiotics, provide wound care, encourage breastfeeding (for mastitis), educate on hygiene

Thromboembolic Disorders

• Deep Vein Thrombosis (DVT): Blood clot in a deep vein, usually in the leg
• Pulmonary Embolism (PE): Blood clot that travels to the lungs Cause: Venous stasis, hypercoagulability, blood vessel injury
• Risk Factors: Cesarean birth, obesity, immobility, history of thrombosis
• Signs and Symptoms: Leg pain, swelling, warmth, shortness of breath, chest pain
• Nursing Actions: Prevention (ambulation, compression stockings), administer anticoagulants, monitor for signs of PE

Mental Health Disorders

• Postpartum Blues: Transient sadness, tearfulness; resolves within a few weeks
• Postpartum Depression: Persistent sadness, loss of interest, changes in appetite and sleep, feelings of guilt or worthlessness
• Postpartum Anxiety: Excessive worry, panic attacks, intrusive thoughts
• Postpartum Psychosis: Rare; hallucinations, delusions, disorganized thinking
• Risk Factors: History of mental illness, stressful life events, lack of support
• Nursing Actions: Screening for mood disorders, providing support and education, referring to mental health professionals, safety assessment

Newborn Transition to Extrauterine Life

• First Breath and Establishment of Respiratory Function: Initiated by chemical, mechanical, thermal, and sensory factors
• Cardiovascular Changes: Closure of fetal shunts (ductus arteriosus, foramen ovale, ductus venosus)
• Thermoregulation: Maintaining body temperature; newborns are prone to heat loss due to a high surface area to body mass ratio
• Hepatic Function: Glycogen stores are converted into glucose, bilirubin conjugation
• Gastrointestinal Function: Meconium is passed, digestion and absorption of nutrients begin
• Renal Function: Limited ability to concentrate urine during the first few months
• Immune System: Passive immunity from maternal antibodies

Newborn Assessment

• Apgar Score: Assesses heart rate, respiratory effort, muscle tone, reflex irritability, and color at 1 and 5 minutes after birth
• Vital Signs: Heart rate, respiratory rate, temperature, blood pressure
• Physical Assessment: Head-to-toe examination to identify abnormalities
• Gestational Age Assessment: Evaluates physical and neuromuscular maturity to determine gestational age
• Weight, Length, and Head Circumference: Measurements to assess growth

Newborn Nursing Care

• Thermoregulation: Drying the newborn, skin-to-skin contact, radiant warmers
• Respiratory Support: Clearing airway, administering oxygen if needed
• Cardiovascular Support: Monitoring heart rate and blood pressure
• Feeding: Breastfeeding or formula feeding, assessing suck and swallow
• Skin Care: Bathing, cord care
• Elimination: Monitoring urine and stool output
• Safety: Preventing infection, preventing falls, educating parents on safe sleep practices

Newborn Nutrition

• Breastfeeding: Recommended for the first 6 months, provides optimal nutrition and immunological benefits
• Formula Feeding: Alternative to breastfeeding, various formulas available to meet the newborn's nutritional needs
• Feeding Cues: Recognizing signs of hunger (rooting, sucking on hands)
• Feeding Techniques: Proper latch, positioning, frequency, and duration of feeding
• Weight Gain: Monitoring weight gain to ensure adequate nutrition

Common Newborn Problems

• Jaundice: Yellowing of the skin due to elevated bilirubin levels
• Hypoglycemia: Low blood sugar
• Respiratory Distress: Difficulty breathing
• Congenital Anomalies: Birth defects
• Infections: Sepsis, pneumonia

Newborn Safety

• Safe Sleep Practices: Back to sleep, firm mattress, no loose bedding, no co-sleeping
• Car Seat Safety: Rear-facing car seat until age 2 or until the child reaches the maximum height and weight
• Preventing Infection: Hand hygiene, avoiding crowds, proper cord care
• Preventing Falls: Never leaving the baby unattended on a high surface
• Shaken Baby Syndrome: Educating parents on the dangers of shaking a baby

Parent Education

• Newborn Care: Feeding, bathing, diapering, cord care, recognizing signs of illness
• Postpartum Care: Self-care, warning signs, emotional support
• Safe Sleep Practices: Reducing the risk of SIDS
• Immunizations: Importance of vaccines
• Follow-Up Appointments: Scheduling well-baby visits
• Resources and Support: Connecting parents with community resources